Active NPI 1811929243 Individual Practitioner Male Practitioner

Dr. Bryce D Beseth , MD

Surgery • Upland, CA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Bryce Beseth, MD is a certified Surgery practicing in Upland, CA. With approximately 30 years of clinical experience since graduating from University Of California, Geffen School Of Medicine in 1996, Dr. Beseth delivers high-quality medical care to the local community at 510 N 13TH AVE.

Dr. Beseth maintains professional affiliations with Wound Healing Care Specialists Inc, Wallace G Gosney Md And Gilbert R Turner Md Ptrs and accepts Medicare assignment.

Frequently performed procedures and clinical services include subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least, established patient outpatient office visit, removal of muscle and/or tissue, 20.0 sq cm or less. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

510 N 13th Ave
Ste 204

Upland, CA 917864965

Telephone 9099200525

Fax 9099200526

Associated Practice Facility / Clinic

🏢 Wallace G Gosney Md & Gilbert R Turner Md Ptrs Facility NPI 1376569657

Medicare Profile & Education

Medical School

University Of California, Geffen School Of Medicine

Graduation Year

1996

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Upland, CA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

30 Yrs Matches City Avg

City Avg: 30.0 Yrs

State Avg: 27.4 Yrs

Regional Practice Density

9 Specialists

Practicing in Upland, CA (3346 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

65.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Beseth (30 Years) 30 Yrs

Upland Specialty Average (30.0 Years) 30.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	700	102	$229.63	$77.46
99213 Established patient office or other outpatient visit, typically 15 minutes	456	270	$225.00	$97.10
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	455	85	$490.55	$246.25
11042 Removal of skin and tissue, 20.0 sq cm or less	402	107	$340.20	$130.82
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	376	87	$121.54	$79.61
11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less	365	41	$176.82	$76.57
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	308	76	$200.00	$82.27
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	284	31	$70.18	$42.42
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	206	206	$630.00	$234.90
93990 Ultrasound of dialysis access	123	56	$340.00	$142.74
93925 Ultrasound of leg arteries or artery grafts	111	79	$825.00	$266.37
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	92	89	$545.00	$180.66
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	74	36	$222.97	$77.19
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	43	43	$250.00	$82.79
99342 Residence visit for new patient with low level of medical decision making, per day, if using time, at least 30 minutes	28	28	$237.50	$81.41
93970 Ultrasound study of arm or leg veins with compression and maneuvers	27	27	$635.00	$200.81
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	24	16	$603.13	$157.98
11042 Removal of skin and tissue, 20.0 sq cm or less	21	13	$383.57	$62.49
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	20	20	$395.00	$130.90
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	14	14	$380.00	$192.40
93931 Ultrasound of one arm arteries or artery grafts	14	14	$350.00	$137.15
36820 Relocation of forearm vein with connection to arm artery for hemodialysis	13	12	$2335.00	$739.05
36821 Relocation of arm vein with connection to arm artery, open procedure	13	12	$1950.00	$613.45
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$280.00	$119.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	435	255	$225.00	$94.98
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	433	96	$176.11	$76.32
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	296	73	$200.00	$82.00
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	213	213	$630.00	$229.49
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	133	51	$460.12	$241.29
11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less	124	16	$182.74	$75.19
93925 Ultrasound of leg arteries or artery grafts	122	92	$822.05	$261.72
11042 Removal of skin and tissue, 20.0 sq cm or less	119	45	$295.83	$135.38
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	97	85	$545.00	$179.75
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	88	79	$175.89	$82.22
93990 Ultrasound of dialysis access	81	43	$340.00	$139.59
11045 Removal of skin and tissue, each additional 20.0 sq cm or less	79	12	$101.07	$41.46
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	69	33	$198.83	$76.18
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	55	12	$250.00	$84.83
93970 Ultrasound study of arm or leg veins with compression and maneuvers	51	48	$635.00	$197.63
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	33	33	$168.20	$83.76
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	33	14	$471.84	$156.48
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	29	26	$395.00	$130.01
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	28	14	$289.49	$123.33
11042 Removal of skin and tissue, 20.0 sq cm or less	27	17	$249.76	$57.82
99347 Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes	21	21	$140.00	$45.55
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	20	19	$110.88	$40.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	17	17	$280.00	$117.99
36821 Relocation of arm vein with connection to arm artery, open procedure	16	16	$1950.00	$670.99
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	16	16	$376.25	$188.04
47562 Removal of gallbladder using an endoscope	12	12	$2050.00	$683.28
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	11	11	$222.91	$109.00

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	510	101	$200.00	$74.17
99213 Established patient office or other outpatient visit, typically 15 minutes	435	249	$225.00	$96.09
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	206	206	$630.00	$233.04
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	190	71	$122.46	$71.04
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	139	127	$545.00	$206.23
11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less	116	14	$133.55	$77.73
93990 Ultrasound of dialysis access	111	47	$340.00	$144.12
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	104	39	$445.93	$249.64
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	75	19	$290.00	$106.58
11042 Removal of skin and tissue, 20.0 sq cm or less	69	29	$246.23	$126.03
93925 Ultrasound of leg arteries or artery grafts	68	49	$825.00	$267.36
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	37	27	$122.46	$70.85
93970 Ultrasound study of arm or leg veins with compression and maneuvers	33	28	$635.00	$202.48
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	32	32	$158.15	$92.48
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	32	28	$395.00	$132.22
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	29	16	$161.72	$92.58
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	23	15	$461.02	$159.80
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$280.00	$118.80
36820 Relocation of forearm vein with connection to arm artery for hemodialysis	19	18	$2335.00	$712.29
47562 Removal of gallbladder using an endoscope	15	15	$2050.00	$702.84
36821 Relocation of arm vein with connection to arm artery, open procedure	14	14	$1950.00	$692.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$280.00	$135.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	484	110	$200.00	$74.97
99213 Established patient office or other outpatient visit, typically 15 minutes	439	235	$225.00	$95.54
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	340	110	$82.94	$72.12
11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less	329	34	$85.51	$78.06
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	237	80	$192.34	$190.27
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	195	195	$630.00	$232.74
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	177	151	$545.00	$208.36
93990 Ultrasound of dialysis access	81	41	$340.00	$142.43
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	78	78	$118.32	$92.89
11042 Removal of skin and tissue, 20.0 sq cm or less	45	27	$80.77	$80.77
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	35	25	$285.14	$160.01
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	34	15	$290.00	$107.62
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	33	21	$83.00	$71.51
47562 Removal of gallbladder using an endoscope	22	22	$2050.00	$685.11
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	22	15	$60.00	$46.23
93970 Ultrasound study of arm or leg veins with compression and maneuvers	21	21	$635.00	$214.15
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	19	17	$395.00	$129.17
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	17	17	$280.00	$113.86
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	16	16	$380.00	$192.11
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	16	16	$118.00	$92.68
36821 Relocation of arm vein with connection to arm artery, open procedure	15	15	$1950.00	$693.63
36820 Relocation of forearm vein with connection to arm artery for hemodialysis	13	13	$2335.00	$754.46
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$280.00	$137.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	540	122	$200.00	$76.38
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	294	79	$140.00	$46.85
11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less	284	27	$223.04	$59.54
99213 Established patient office or other outpatient visit, typically 15 minutes	274	180	$225.00	$78.03
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	233	70	$514.31	$164.81
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	225	68	$213.83	$73.81
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	178	178	$630.00	$218.18
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	173	150	$545.00	$212.47
93990 Ultrasound of dialysis access	85	48	$340.00	$146.88
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	81	81	$278.00	$95.99
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	66	19	$248.86	$198.42
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	66	21	$83.00	$73.65
11042 Removal of skin and tissue, 20.0 sq cm or less	47	18	$202.36	$64.74
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	35	14	$289.59	$101.27
47562 Removal of gallbladder using an endoscope	22	22	$2050.00	$627.68
27880 Amputation of both lower leg bones	15	15	$2565.00	$1006.67
36821 Relocation of arm vein with connection to arm artery, open procedure	14	14	$1950.00	$681.30
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	14	14	$118.00	$96.06
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$280.00	$111.59
36830 Connection of tube graft to vein and artery for dialysis	12	11	$1930.00	$472.22
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	11	11	$380.00	$151.68

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	537	134	$200.00	$74.98
99213 Established patient office or other outpatient visit, typically 15 minutes	261	179	$225.00	$77.64
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	190	178	$545.00	$208.50
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	186	186	$630.00	$214.50
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	159	45	$215.00	$71.53
93990 Ultrasound of dialysis access	144	71	$340.00	$145.04
11043 Removal of muscle and/or tissue, 20.0 sq cm or less	96	27	$517.34	$160.46
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	85	27	$83.00	$71.41
93923 Complete ultrasound study of arm and leg arteries	54	54	$575.00	$22.78
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	40	40	$280.00	$93.26
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	38	38	$118.00	$93.07
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	38	38	$430.00	$167.00
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	32	16	$60.00	$45.62
36821 Relocation of arm vein with connection to arm artery, open procedure	32	31	$1950.00	$663.80
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	18	$115.00	$47.42
47562 Removal of gallbladder using an endoscope	20	20	$2050.00	$684.42
93970 Ultrasound study of arm or leg veins with compression and maneuvers	18	18	$575.00	$209.78
36830 Connection of tube graft to vein and artery for dialysis	17	15	$1930.00	$445.20
36820 Relocation of forearm vein with connection to arm artery for hemodialysis	14	14	$2335.00	$756.92
36832 Revision of dialysis graft, open procedure	14	14	$1930.00	$780.03
35011 Repair of diseased or bulging (aneurysm) artery of arm	13	11	$2970.00	$1031.50
37607 Tying or banding of a passage between an artery and vein	12	11	$1095.00	$242.40
35301 Removal of blood clot and portion of artery of neck	11	11	$3135.00	$1162.92
11042 Removal of skin and tissue, 20.0 sq cm or less	11	11	$229.55	$61.43

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	424	126	$200.00	$74.35
99213 Established patient office or other outpatient visit, typically 15 minutes	273	202	$225.00	$75.35
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	210	184	$545.00	$206.19
93990 Ultrasound of dialysis access	171	76	$340.00	$145.53
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	158	158	$630.00	$211.26
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	83	83	$430.00	$167.94
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	79	70	$115.00	$45.76
93923 Complete ultrasound study of arm and leg arteries	68	68	$575.00	$22.44
36821 Relocation of arm vein with connection to arm artery, open procedure	37	36	$1950.00	$675.55
93970 Ultrasound study of arm or leg veins with compression and maneuvers	22	22	$575.00	$211.00
47562 Removal of gallbladder using an endoscope	20	20	$2050.00	$588.71
36830 Connection of tube graft to vein and artery for dialysis	14	14	$1930.00	$532.47
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$280.00	$111.27
36819 Relocation of arm vein with connection to arm artery, open procedure	11	11	$2330.00	$743.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	405	122	$200.00	$71.48
99213 Established patient office or other outpatient visit, typically 15 minutes	198	161	$225.00	$72.64
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	193	171	$545.00	$199.47
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	181	181	$430.00	$161.67
93990 Ultrasound of dialysis access	158	63	$340.00	$142.91
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	132	104	$115.00	$43.80
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	71	71	$630.00	$205.43
36821 Relocation of arm vein with connection to arm artery, open procedure	42	42	$1950.00	$653.97
93923 Complete ultrasound study of arm and leg arteries	36	36	$575.00	$22.05
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	24	$280.00	$107.69
47562 Removal of gallbladder using an endoscope	24	24	$2050.00	$597.46
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	18	18	$280.00	$107.83
49505 Repair of groin hernia (5 years or older)	16	16	$1370.00	$501.09
35301 Removal of blood clot and portion of artery of neck	14	14	$3135.00	$1110.85
55520 Removal of spermatic cord growth	14	14	$1350.00	$231.81
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	13	11	$370.00	$124.22
36832 Revision of dialysis graft, open procedure	12	12	$1930.00	$745.73

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License CA A65402

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Surgery - Vascular Surgery

NUCC Taxonomy Code: 2086S0129X

State License CA A65402

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

Hospital & Practice Group Affiliations

Wallace G Gosney Md And Gilbert R Turner Md Ptrs

510 N 13th Ave, Upland, CA 917864965

Phone: 9099200525

Wound Healing Care Specialists Inc

3536 Concours, Ontario, CA 917645585

Phone: 90994404865585

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Dr. Bernice Tan , DNP NP

Nurse Practitioner

NPI 1033749270

DNPNP

Gay Beseth , NP

Nurse Practitioner

NPI 1346398286

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active March 15, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location March 15, 2016

Registered at 510 N 13TH AVE, STE 204, UPLAND, CA 917864965 (Tel: 9099200525)

📍

Updated Business Mailing Address March 15, 2016

Registered at 510 N 13TH AVE, STE 204, UPLAND, CA 917864965 (Tel: 9099200525)

👤

Provider Name / Credentials Updated March 15, 2016

Recorded as BRYCE BESETH, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 15, 2016

Surgery (License #A65402 in CA)

🟢

Initial NPI Registration & Enumeration July 07, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1811929243

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 07, 2006

Last Update: March 15, 2016

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

510 N 13th Ave, Ste 204

Upland, CA 917864965

Phone: 9099200525

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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